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Assessing the barriers and facilitators of access to diabetic retinopathy screening in sub- Saharan Africa: a literature review

Abstract

Diabetic retinopathy (DR) is the leading cause of blindness in working age adults. An increase in visual loss has been projected for sub-Saharan Africa (SSA) with the diabetes epidemic in the region. Screening is a cost-effective way to reduce this scourge, but adequate services are scarce. This review aims to evaluate the evidence on barriers and facilitators of access to DR screening with a view to making evidence-based recommendations for the development of effective and sustainable programmes in SSA. A systematic literature search of Africa-Wide Information, Embase, Cochrane library, Global Health, and Medline databases was done using diabetic retinopathy, screening, and Sub-Saharan Africa as concepts. Google Scholar was also searched to identify relevant literature. Studies were included if they were done in SSA and reported on barriers and/or facilitators of access to DR screening. The database search yielded 616 papers and google scholar yielded 9223 papers. Of these, 54 papers were assessed for eligibility and 18 met the inclusion criteria. These were appraised with appropriate checklists. Fourteen themes were synthesised. Most were supply challenges affecting all dimensions of access and the six components of the health systems building blocks. Several studies had poor methodologies, and this has implications for the evidence provided. The findings of this review show a weakness in the health systems suggesting this is the major indirect barrier to DR screening in SSA. Measures to strengthen the health system for DR screening is strongly recommended.

摘要

糖尿病视网膜病变(DR)是工作年龄成年人失明的主要原因。随着糖尿病在亚撒哈拉以南非洲地区 (SSA) 的流行, 预计失明将会增加。筛查是减少该病的一种具有成本效益的方法, 但是在服务方面仍旧欠缺。本综述旨在评估DR筛查中的障碍及促进因素的证据, 为SSA制定有效和可持续发展提出循证建议。

对Africa-Wide Information、Embase、Cochrane图书馆、全球健康和Medline数据库进行了系统的文献检索, 使用糖尿病视网膜病变、筛查和撒哈拉以南非洲作为主题词。使用谷歌学术搜索也来识别相关文献。研究如果在SSA开展并报告DR筛查的障碍和/或促进因素的研究则纳入本研究。数据库共搜寻到616篇论文, 谷歌学术9223篇论文。其中, 54篇论文具有符合评估标准, 18篇符合入选标准。评估表对这些研究进行总结与评估。

我们对十四个主题进行了分析。大多数是供应方面的挑战, 影响获取的各个方面卫生系统的六个组成部分方面的障碍。一些研究的方法论不佳, 这对所提供的证据有影响。

本综述结果显示了卫生系统的弱点, 是SSADR筛查中主要存在的间接障碍。本文强烈建议采取措施加强卫生体系中DR筛查系统。

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Fig. 1: A flow diagram showing the steps taken to identify the eligible studies included in the review.

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EOA was responsible for designing the protocol for the review, conducting the search, screening for eligible studies, critical appraisal of studies, extracting data, data analysis, and interpretation, writing, summarising the findings, and approved the final version. OEO contributed to screening for eligible results, data analysis, writing the report, reviewed the manuscript, and approved the final version. NCO contributed to the initial searching as well as screening for eligible studies, data extraction, analysis, writing of the review, and approved the final version. AM was involved in the designing and writing of the review protocol, interpreting results, reviewed the manuscript, and approved the final version.

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Correspondence to Eberechukwu Ogbeanu Achigbu.

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Achigbu, E.O., Onyia, O.E., Oguego, N.C. et al. Assessing the barriers and facilitators of access to diabetic retinopathy screening in sub- Saharan Africa: a literature review. Eye (2023). https://doi.org/10.1038/s41433-023-02673-y

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